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Selective serotonin reuptake inhibitors and increased bleeding risk: are we missing something?
1HeartDrug Research Laboratories, Johns Hopkins University, Baltimore, Md, USA. heartdrug@aol.com
The American Journal of Medicine
|January 31, 2006
Summary
Selective serotonin reuptake inhibitors (SSRIs) increase bleeding risk due to platelet dysfunction. Physicians should monitor patients, especially those on antiplatelet agents, for SSRI-induced hemorrhages.
Area of Science:
- Pharmacology
- Hematology
- Psychiatry
Background:
- Selective serotonin reuptake inhibitors (SSRIs) are primary treatments for depression.
- SSRIs generally have a good safety profile, but bleeding events have been reported.
- Platelet dysfunction due to serotonin reuptake blockade is a suspected mechanism for SSRI-related bleeding.
Purpose of the Study:
- To review evidence linking SSRIs to bleeding episodes.
- To define the prevalence and characteristics of SSRI-associated bleeding.
- To estimate the risk of bleeding when SSRIs are combined with antiplatelet or anticoagulant medications.
Main Methods:
- Literature review of MEDLINE-cited papers and online resources.
- Analysis of case reports, registries, and uncontrolled studies.
- Examination of evidence on SSRI use with antiplatelet and anticoagulant agents.
Main Results:
- Over 120 peer-reviewed papers and 50,000 web pages discuss SSRI-related bleeding.
- SSRIs are consistently associated with an increased risk of bleeding events.
- The frequency of these bleeding complications is increasing.
Conclusions:
- SSRIs are linked to a higher risk of bleeding, regardless of the specific drug.
- Physicians must be aware of SSRI-induced hemorrhages, particularly in patients with platelet disorders or on antiplatelet therapy.
- Further prospective studies are needed to assess long-term bleeding risks with concomitant SSRI and antiplatelet use.